both a modified Hungerford and Kenna knee rating system and Insall and Crosby grading system, and asking whether surgery had been worthwhile and whether they would go through it again. Serial radiographs were assessed for patellar malalignment, mechanical failure and progressive arthritic change in the knee, and failure was defined as a fairlpoor knee score or revision.
Preoperatively 17 knees had undergone arthroscopy. 36 Lubinus, 17 Cartier and 2 PFV prostheses were used. 5 patients died with 8 PF arthroplasties in situ, 1 patient lost to follow up (these patients are not included further in the analysis). 48 Patellofemoral arthroplasty knees were reviewed. 38 knees were classed as good or excellent, 10 had unsatisfactory results, and 7 were revised. 5 implants were revised to TKR and 2 were revised to PF arthroplasty (for maltracking). Subjectively 41 patients felt they were better, 5 unchanged and 2 worse. Overall we had 69% good or excellent results, 18% poor, and 12% revised. There were no infections, no revision for loosening, and no documented difficulty in revisions. The worst results were obtained in patients with evidence of tiblo-femoral OA preoperatively and in patients with tracking problems.
We assessed the influence of the use of a tourniquet in total knee arthroplasty in a prospective, randomised study. After satisfying exclusion criteria, we divided 77 patients into two groups, one to undergo surgery with a tourniquet and one without. Both groups were well matched. The mean change in knee flexion in the group that had surgery without a tourniquet was significantly better at one week (p = 0.03) than in the other group, but movement was similar at six weeks and at four months. There was no significant difference in the surgical time, postoperative pain, need for analgesia, the volume collected in the drains, postoperative swelling, and the incidence of wound complications or of deep-venous thrombosis. We conclude that the use of a tourniquet is safe and that current practice can be continued.
